Arch Phys Med Rehabil
. 2021 Apr 23;S0003-9993(21)00307-5.
doi: 10.1016/j.apmr.2021.03.026. Online ahead of print.

Is aerobic or resistance training the most effective exercise modality for improving lower extremity physical function and perceived fatigue in people with multiple sclerosis? A systematic review and meta-analysis

Laurits Taul-Madsen 1, Luke Connolly 2, Rachel Dennett 2, Jenny Freeman 2, Ulrik Dalgas 3, Lars G Hvid 3
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Objective: The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (pwMS).

Data sources: Nine databases (MEDLINE, EMBASE, CINAHL, AMED, PEDro, SPORTdiscus, PsycINFO, Web of Science and SCOPUS) were electronically searched in April 2020.

Study selection: Included studies were randomized controlled trials (RCTs) involving pwMS attending one of two exercise interventions; AT or RT. Studies had to include at least one objective or self-reported outcome of lower extremity physical function and/or perceived fatigue.

Data extraction: Data was extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions and outcomes. The methodological quality of the included studies was independently assessed by two reviewers using the TESTEX rating scale.

Data synthesis: Twenty-seven papers reporting data from 22 RCTS (AT=14, RT=8) including 966 pwMS. The two modalities were found to be equally effective in terms of improving short walk test (AT: ES=0.33 [-1.49: 2.06]; RT: ES=0.27 [0.07: 0.47]) and long walk test performance (AT: ES=0.37 [-0.04: 0.78]; RT: ES=0.36 [-0.35: 1.08]), as well as in reducing perceived fatigue (AT: ES=-0.61 [-1.10:-0.11]; RT: ES=-0.41 [-0.80: -0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive.

Conclusions: AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in pwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus 'core battery' of physical function tests to facilitate a detailed comparison of results across modalities.